Risk factors for major complications after extrapleural pneumonectomy for malignant pleural mesothelioma

Background. Factors associated with increased risk of major complications after extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma are not well characterized; in particular, the risks of induction chemotherapy and red blood cell (RBC) transfusion have not been well defined. Methods. We reviewed our experience with 62 consecutive EPP (28 right sided) performed in our institution for malignant pleural mesothelioma between January 1993 and May 2007. A total of 44 patients underwent induction chemotherapy with cisplatin-based therapy. Results. The majority of patients (88%) received RBC transfusions (median, 4 units; range, 0 to 18 units). Patients undergoing induction chemotherapy had lower preoperative hemoglobin (122 +/- 16 g/ L versus 134 +/- 15 g/ L in the remaining patients, p = 0.02) and received more RBC transfusions (5.1 +/- 3.5 units versus 2.1 +/- 2.3 units in the remaining patients, p = 0.007). Twenty-two patients (35%) experienced major postoperative complications and 4 of them died (6.5%). Patients experiencing major complications were older (60 +/- 8 years versus 56 +/- 12 years, respectively; p = 0.2) and received more RBC transfusions (5.8 +/- 4.3 units versus 3.7 +/- 2.7 units, respectively; p = 0.02). Major complications occurred more frequently after right-sided EPP than after left-sided EPP (54% versus 21%, p = 0.007). Induction chemotherapy had no impact on the risk of major complications (p = 0.5). Transfusion of more than 4 units of RBC (p = 0.01) and right-sided EPP (p = 0.01) were associated with increased risk of major complications after EPP in multivariate analysis. Conclusions. Right EPP and more than 4 units of RBC transfusion are associated with increased risk of major complications. Although patients undergoing induction chemotherapy received more RBC transfusions, induction chemotherapy did not directly impact the risk of major complications.